内镜切除与开放手术治疗早期食管癌的对比研究

A comparative study on endoscopic resection and open esophagectomy for early esophageal cancers

目的对比早期食管癌内镜切除治疗和开放手术治疗的疗效。方法回顾性总结2008年2月到2013年3月间43例内镜切除治疗（内镜切除组）和29例开放性手术治疗（开放手术组）早期食管癌患者的临床资料，对比分析2组术后并发症发生情况、3年内肿瘤复发情况及术后5年生存率。结果开放手术组术后发生反流性食管炎11例（37．9％）、食管狭窄7例（24．1％）、吻合口漏1例（3．4％），内镜切除组术后发生反流性食管炎5例（11．6％）、食管狭窄6例（14．0％），内镜切除组术后反流性食管炎发生率明显低于开放手术组（P〈0．05）。开放手术组术后3年内复发2例（6．9％）、术后5年生存率为82．8％（24／29），内镜切除组术后3年内复发5例（11．6％）、术后5年生存率为86．0％（37／43），2组术后3年内复发率、术后5年生存率均相近（P〉0．05）。结论对于早期食管癌患者，内镜切除治疗能获得与开放手术治疗相似的疗效，并能明显减少术后反流性食管炎的发生，改善患者生活质量。

Objective To compare the value of endoscopic resection and open esophagectomy for early esophageal cancers. Methods A total of 43 endoscopic resections and 29 esophagectomies were performed on 72 patients from February 2008 to March 2013. Postoperative complications （ e. g. reflux esophagitis, anastomotic stenosis, and stomal leak）, three-year recurrence rate and five-year survival rate were compared. Results The incidence of reflux esophagitis, esophageal stenosis and stomal leak in the esophagectomy group were 37.9% （11/43）,24. 1% （7/43）, 3.4% （1/43）, while the incidence of reflux esophagitis and esophageal stenosis in the endoscopic resection group were 11.6% （5/29） and 14.0% （6/ 29） respectively. The incidence of reflux esophagitis in the endoscopic resection group was significantly lower than the open esophagectomy group （P 〈 0. 05）. There was no significant difference in the 3-year recurrence rate[ 11.6% （5/43） VS 6. 9% （2/29） ]or the five-year survival rate[ （86. 0% （37/43） VS 82. 8% （24/29） ] between the endoscopic resection group and the esophagectomy group （P 〉 0. 05 ）. Conclusion The endoscopic resection is of the similar effects on early esophageal cancers, compared with open surgery, but can reduce the incidence of postoperative reflux esophagitis and improve the living standard.